| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
405 |
362 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
410 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
117 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
363 |
329 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
339 |
301 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
15 |
$4K |
| D0272 |
Bitewings - two radiographic images |
98 |
84 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
36 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
69 |
$945.09 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$366.20 |
| D0603 |
|
32 |
32 |
$70.00 |